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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> b <br /> Applicant Complete All Sections Below This Line '• c <br /> Permit Types and Fees:(Please,check appropriate boxes) a. <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 d C <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 -C- <br /> 3 'Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $150 O <br /> O <br /> Accessory Structure(Commercial/Industrial) $200_ Addition/Alteration to Bunkhouse $150 :; <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse .$250 v <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 $' D <br /> Filling/Grading $150 Boathouse $500 r U I <br /> 0 <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 -- G <br /> *NOTE:After-the-fact permits(permit squired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. ro <br /> Property Owner's Name: JOXlf/VNI kV1 Al2-1 g D,t1 A til ° z <br /> p <br /> Property Owner's Mailing Address: a` Li 3 3 v l "r N N'C L S 0 A-- 4- c1 - o <br /> i- City State Zi <br /> Property Site Address: M C I QC Nt J ,, 5"� 7a- c o <br /> /- <br /> Contact's Telephone Number: (!� 16 — I7 3 g o y <br /> Contact's Email: t1'1 d C <br /> cp <br /> Legal Description of Property: .. 3 <br /> N ry <br /> Section#: Town#: N Range#: W Town of: 0 4 N! "- Ls o °G <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* <br /> O Lo <br /> Tax ID#(1-5 digit number; found on tax statement): 3 513 .2., <br /> Proposed Use of Structure/Addition: 5T0 a-A 6-t= S HiL A 5CA <br /> Anticipated Start Date: (Home/Cabin;Commercial Business;Bedroom;Deck;etc.) c X <br /> 0 <br /> Building Contractor: Sewer Installer: ,V l= S i-1 o L-rvk d <br /> .--3 V <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: W <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to (a ) <br /> ANY construction taking place for any dwellings, dwelling additions,manufactured homes,manufactured z 7—' <br /> home additions,and bunkhouses.** Pv <br /> d cheek-- J se4k ,, <br /> e, (None c4 4145e 51-Yuc6A.ie.5 ckeejmi h,,/flat/ 14 b,' -fioA. <br /> Q Dec lk ileeLs fleck 144 v5e fet"`"t+ b 0111 )-1 _ <br /> (10Cle:rs A'lutsf . lye,'GAf (o�l f1e bra 1RG l' Fee Rec tJd- <br /> 1. UiC /I! !:r Q/l1 K tt. v Check#: L+307 <br /> V1" � 1u � mDate of staff site vii N I; I Initials of • to visit staff: f1 L z <br /> 0 <br /> APPROVED BY LAND SERVICES OFFICIAL: �� // v.----- DATE: `f�/i8/g-/ < �,---' <br /> UPON APPROVAL: APPLICA a'a` MUST POST COPY OF a o <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT z s 'nrt <br /> rr w - Uu <br /> Transcendent: - Page 1 of 4 n no <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 < g <br /> o <br /> a <br /> 3 <br />